Right knee fused for over 20 years; thinking about tkr

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new member

I injured my right knee in 1980 when I got a crochet needle stuck in it (story for another day). The damage this caused my knee joint along with my doctor's bad judgement at the time led to years of knee surgeries and knee/back pain. My knee became arthritic and had to be drained of liquid via arthoscopic knee surgery several times. After several of these surgeries a doctor finally advised me to have my right knee fused completely straight with no degree of flexation what so ever; my knee joint was toast! So, in 1990 it was fused straight and I have not been able to bend it since (well, after a few accidents it did bend a few times! OUCH!!!!!!!) This also put a end to my competitive swimming career as I could no longer do flip turns. Well, I could still do them but they looked funny as hell.

Needless to say, this changed my life in many ways but unlike most people who face diversity and give up I did not throw in the towel. I spent my entire childhood being told I couldn't do things because of my knee or being treated like a fragile piece of glass that even the slightest touch would break me. My doctor told me I would never ride a bike again and I proved him wrong! My doctor and family told me I would never play sports and I proved them all wrong ( I play ice hockey, soccer, and tennis to name a few and I play them better than people with two good knees which I'm really proud of). I have embraced my disability and proven everyone wrong time and time again.

So, I learned to live with the hand I was dealt but there has always been this voice in the back of my mind saying "you do all these things with a fused right knee, imagine if that knee could bend again????" I can't tell you how many times refs and opposing players come up to me on the ice at my hockey games and say "did you hurt yourself?" I tell them my right knee is fused straight and they are left in disbelief at how good a player I am. I have had discussions with doctors about knee replacments in the past but most of the time I have been told to wait until I was over 60 and have trouble walking etc. I also understand that if I was to have a tkr done my recovery would be much more difficult then say a person who could at least bend their damaged knee still. There are many unanswered questions. What is the state of my ligaments in that knee after 20 years of no movement? My quadricept and hamstring are considerably smaller than my left due to not being able to bend the knee. Would I have to train my mind to make me bend the knee again? etc etc As you can see there are many factors involved in this decision as I'm sure many of you know.

To finish this off, I was hoping I might meet others on this site who have maybe faced a similar situation to mine. Having a knee that was fused and then got a tkr done. I think hearing some other people's stories about the surgery and recovery would be a great help. I actual did meet one guy in a similar boat as me and he got his left fused knee replaced. However, he told me it was the worst decision he ever made in his life. Last I heard he was seriously contemplating amputation for a prostectic due to the advancement in prostecies (don't know if I spelled that right). His story didn't do much to lean me toward tkr but he was just one person.

ADMINISTRATOR

Hi, Damaso77....welcome to BoneSmart! Boy, you certainly have a unique story....very inspiring with all you have been able to accomplish despite your knee problems.

Our forum nurse, Josephine, may be able to provide some comments for you from a medical perspective. I cannot recall anyone on BoneSmart who has had similar circumstances. But that really doesn't mean anything. If you are interested in pursuing a TKR, I think you should start talking to some surgeons. @Josephine:

The Canadian medical system (from what I've heard from our Canadian members) can sometimes present some problems either in terms of what will be done or how long it takes. Do you have any means for private pay or to come to the United States to meet with surgeons? That might get you a few more options than you would have within your national health care program. The key factor for you will be finding a surgeon who can deal with your situation....not all orthopedic surgeons would have the level of expertise to guide you through not only the surgery, but also what may be a pretty rough recovery. After all, you are going to have years to make up in terms of muscle strength and tissue flexibility.

But....if it could be done...what a wonderful thing it would be. I say start checking things out!!!

new member

Thanks Jamie! I definitely know there will be lots of hard work that will be needed if I do have tkr done. The type of medical attention my situation would require is definitely one of my main concerns about tkr. Quite honestly the thought of my progress to this point being put in jeopardy is a big risk in my mind. I don't know if I could handle it not working out for me. But, I didn't get to where I am by planting seeds of doubt.

ADMINISTRATOR

Well, you certainly lose nothing by checking out your options. Knowledge is power and I feel like if you met with a few potential surgeons and discussed what may or may not be possible, you will see the path that is best for you.

NURSE DIRECTOR EMERITUS

Hi there, Damas. I've seen a lot of fused hip joints picked apart and given a replacement in the past. How they did afterwards I have no idea as I worked in the OR at the time. But a knee?

There are logistical issues like how was your knee fused? Was a rod used? Did they cut the bone and let it heal together? If the latter, it might depend upon how much bone was resected then. In the old days, such a fusion was the fall-back procedure for a failed knee replacement.

And then, as you so rightly pointed out, there is the issue of your ligaments and muscles. Though I suspect they might be in better shape than you think given the sports activities you engage in!

Truly, I have nothing much to add except I would be interested to hear what a knee surgeon has to say about it. I would strongly suggest you see a revision or reconstruction surgeon rather than a regular knee chap. Can you make that choice in Canada? It really would be essential for your case.

new member

Thanks Josephine for your advice. To be quite honest, I'm not totally sure how they fused my knee. I would have to ask my mom if she knows/remembers the procedure. All I remember is, they put my leg in a cast for 4 months and when they took it off my knee no longer bent. I was put under for the procedure so they may have done something internally to the knee. I know they did not use any pins, I seem to recal them using the term "natural fuse". Both Jamie and yourself have given me some good information and I will look into meeting with a Canadian professional to see what they have to say or think. I am eager to hear what the possibilites could be for my situation.

NURSE DIRECTOR EMERITUS

I that case I would imagine they probably trimmed the ends of the femur and tibia, providing a flat surface that would heal together. That will be find provided they didn't resect too much of the bone.

Four months?! You must have been so pleased to finally get rid of that cast!

junior member

hello and thanks for posting your situation - can you tell us how your doing with your TKR now? I see your in UK where abouts did you get your TKR done and was there any complications/concerns by the OS before hand?

NURSE DIRECTOR EMERITUS

At 14?? Wow - if I may ask, what was the reason for that? We could really use more details of your experience as we've had a couple of members in this situation. I'm really glad it got resolved for you.

new member

Hi Mandy41, You sound like just the person I need to speak with. I wasn't sure if I would find anyone with a similar situation as me; fused knee to tkr. I would love to hear your story about why your knee was fused and how your tkr went. My knee has been fused for over 20 years and in that time I have learned to live with it beyond what anyone every expected. I hope to hear from you.

Sr Bonesmartie

I have had one case like yours in 32 years. A 64 y.o. male wanted to get rid of the fusion and have a TKR. The biggest problem he had was finding an OS that would perform the operation. Some of the best in the Southern US would not touch it. I will tap into some of my resources and give you some of the latest opinions.
David

There are no clear indications for conversion of knee fusion to total arthroplasty. In this paper we report outcome and complications in 8 patients.PATIENTS AND METHODS:

We reviewed 8 total knee arthroplasties after takedown of previous fusion 24-55 months after the conversion. The original diagnoses were complications following injury in 3 patients, rheumatoid arthritis in 3, complication after chondromalacia in 1 patient and tuberculous arthritis in 1 patient. The age at operation ranged from 31 to 67 years. The time since arthrodesis ranged from 1 to 49 years.RESULTS:

5 patients had to undergo reoperation for postoperative complications. 2 patients experienced recurrence of previous deep infection, which led to thigh amputation in one and chronic fistulation in the other. Only 1 patient had an uneventful course after the conversion procedure, but he died later on due to a heart attack. As another patient also died of cardiovascular disease, 5 of the 8 patients were available for evaluation of knee function. In these patients the knee flexion ranged from 90 to 120 degrees, extension lag ranged from 10 to 40 degrees, and all knees were aligned at 6 to 8 degrees of valgus. The Knee Society clinical scores ranged from 47 to 74, the Womac scores ranged from 9 to 47, and EuroQol ranged from 0.1 to 0.8.INTERPRETATION:

Our findings indicate that conversion of knee arthrodesis to total arthroplasty should only be performed in selected cases, and after giving the patient extensive information about the high risk of rather serious complications.

Sr Bonesmartie

Here is what my OS says. He is a Havard med grad.PER DRL: It is possible, literature says results are very poor. Many have toggle of ROM that is not functional. Probably 60% wish they never had it done and other 50% will go back for more surgery in 10 years with refusions as a shorter or less functional result than the fusion before.FYIDavid

new member

Hi Mandy41, You sound like just the person I need to speak with. I wasn't sure if I would find anyone with a similar situation as me; fused knee to tkr. I would love to hear your story about why your knee was fused and how your tkr went. My knee has been fused for over 20 years and in that time I have learned to live with it beyond what anyone every expected. I hope to hear from you.

Hi Damsco. I was 3 yrs old when I was run over and dragged down the street. My knee was so badley damaged that I had to have numerus operations and the knee removed, then finally at the age of 14 they decided to fuse it with a piece of bone from my hip. Had external fixature on for 21 months. at the age of 28. From the age of 25 I wanted to be able to bend my leg again, and had to fight to get it done. Finally after seeing a brilliant surgeon from Sheffield he decided to take my case on. I had tohave a MRI Scan to see if there was any infections and there had been previously.Scan was clear. First operation was a muscle graft from my thigh on good leg to build the knee area up as I had lost a load of muscle when I was 3. Then a skin graft from my good leg inner thigh. That took ten hours in theatre. I was in hospital a week. I had to wait about 12 months then for the new knee. On this occasion I decided not to have a General but Epidural and Sedation instead. This operation took about ten hours as well. I was in a side ward away from the main ward and after nursing staff did the first dressing change I then did them myself to avoid any infections and it worked. Was in this time about a week. It has now been 8 years,no problems until now. The metal pin at the front of my knee needs replacing as it is a bit loose. Doc says it can be done but it's quite as easy as it sounds. I have never looked back so if you reallywant to be ableto walk properly and bend your knee ...leg go for it and Good Luck to you.